The Value Of The Reserve Of Accessory Spleen In Splenectomy Or Combined-devascularization Operation In Cirrhosis With Portal Hypertension

Objective: To evaluate the value of the reserve of accessory spleens in splenectomyor combined-devascularization which specify cirrhosis with Portal Hypertension.Method: A retrospective analysis was conducted on34cases about the patients ofcirrhosis with Portal Hypertension with accessory spleens in our hospital, who hadsplenectomy from June2004to February2009. They all divided into two groups, ofone group the accessory spleen has been reserved while the other group has theaccessory spleen been cut. All the patients,27of them received Hand-assistedLaparoscopic Splenectomy(10cases in reserving group,17in excision group),3casesof Laparoscopic splenectomy(all in excision group),2cases of open splenectomy (allin cutting group) and other2cases of laparoscopic splenectomy associate withdevascularization (each one in two groups). They were followed up three years to fiveyears, the shortest period is three years, mainly with outpatient follow-up, the otherby letter or phone.There is a lost to follow-up in excision group. To observe therelation between the volume of accessory spleens and content of red blood cells,white blood cells, Platelet and Immunoglobulin(IgM、IgA、IgG) as well as thecondition of complications postoperative which reserved the accessory spleens.Besides,the time spent in operation, the blood loss, hospitalization time, recurrenthemorrhage of postoperation were compared. After collected the data, then used theIBM SPSS Statistics19for data processing, let the P<0.05had great significance inStatistics.Result: The Hyperplasia of accessory spleens grew fast in three years postoperative,but turns slowly after five years. The complications such as spontaneous rupture,torsion which related to accessory spleen had never occurred. Postoperative whiteblood cell and Platelet of these two groups increased significant than preoperativelyin one week, The differences were not so significant between two groups (P>0.05);however, white blood cell and Erythrocyte increased slowly and got stable in normalrange after one month. The differences were not so significant between two groups (P>0.05), the content of IgM、IgA、IgG did not change much in three months in both group, but the group which reserved their accessory spleens had a remarkableincrease than the other after half year, however, the index reached to a normal rangeabout one year. There is no correlation between the volume of accessory spleen,whiteblood cell and immunoglobulin,In the group which reserved accessory spleen,postsplenectomy fever, portal vein thrombosis and those kind of complications wereless occurred and much mild.(P<0.05) there were no significant differences of portalvein thrombosis (P<0.05). the time spent in operation, blood loss, hospitalization time,the rupture and haemorrhage again of the stomach-esophagus vein postoperation wereall not so significant between the two groups (P>0.05).Conclusion: Splenectomy or combined-devascularization of cirrhosis with PortalHypertension which reserved the accessory spleen has short spleen fever and mildsymptom, Half year later, the content of IgM got much higher than the other group,and less severe infection occurred. Accessory spleens may take good effect inpreventing postoperative infection which always caused by decline of immunityamong the patients. There has the value of the reserve of accessory spleens in theoperation, but need to closely observe accessory spleens changes.